Report claims private surgical contracts actually increasing costs, wait times

Brett McKay,
Local Journalism Initiative Reporter

The Alberta government’s outsourcing of surgeries to private surgical centres has led to longer wait times and increased costs, but hasn’t delivered on promised expanded surgical capacity, according to a new report from the Parkland Institute.

Since 2018-19, Alberta provincial spending on contracts to for-profit, chartered surgical facilities (CSF) has increased by 225 per cent, to $55.8 million in 2023-24. During this time, the province added about 16,500 procedures to its overall surgical capacity, an increase of eight per cent.

Report author Andrew Longhurst, a health policy researcher and PhD candidate in the Department of Geography at Simon Fraser University, said this shift to CSFs has come at the expense of public hospitals. While the number of scheduled procedures in CSFs increased from 32,243 in 2019-20 to 50,042 in 2023-24, surgical capacity in hospitals declined one per cent in the same period.

“The most troubling finding, I think, is that public operating room activity was actually lower in the most recent year than even pre-pandemic,” Longhurst said during a webinar on March 26.

“The Alberta Surgical Initiative has cost Albertans $154 million in facility fees paid to these investor-owned facilities to build private infrastructure when existing public operating rooms are sitting idle.”

The Alberta Surgical Initiative (ASI) was launched in 2019 to reduce the backlog of cases and reduce wait times and includes the expanded use of CSFs to meet these targets.

Data from the Canadian Institute for Health Information (CIHI) shows surgical wait times for nine of 11 priority procedures have increased since ASI was introduced.

The report also notes “unusual” cost increases associated with procedures performed at CSFs. From 2019-20 to 2023-24, the average cost per procedure increased by 79 per cent. And between 2022-23 and 2023-24 alone, the average cost per procedure rose 52 per cent, nearly four times higher than the previous annual increase.

“This increase is likely the result of higher negotiated contract prices. The magnitude of this increase is unusual; it cannot be explained by inflation or other reasonable hikes in input costs,” the report says.

Another abnormal finding highlighted in the report is that while surgical volumes at CSFs fell by eight per cent in 2022-23, public payments to these facilities increased.

“These findings seem to corroborate concerns and potential contract irregularities identified by the former Alberta Health Services CEO in her statement of claim and contract prices published by the Globe and Mail,” Longhurst said.

In a statement, Health Minister Adriana LaGrange’s office said the report “selectively highlights data that supports ideological narratives,” and that the use of CSFs “has played a key role in reducing wait times and improving patient care, yet these successes are often dismissed or downplayed in favour of an ideological stance that does not reflect the actual progress we’ve made.”

The CIHI data included in Longhurst’s report shows median wait times for cataract and hip replacement surgeries in Alberta have decreased between 2019 and 2023.

“The increase in cost per procedure since 2019 is primarily due to a shift from shorter, lower-cost surgeries, like cataracts, to more complex orthopedic surgeries such as hip, knee, and shoulder replacements. These surgeries require higher facility fees due to their complexity, longer procedure times, and increased resource utilization, including operating room time, labour, and recovery care. However, we are currently considering changes to the acute care funding model that would increase transparency and accountability and ensure a more sustainable and transparent funding model for acute care in Alberta,” LaGrange’s office said.

Brett McKay,
Local Journalism Initiative Reporter
St. Albert Gazette